Term
| The home health nurse has developed a teaching guide for a client with cardiovascular risk factors that focuses on the importance of regular physical activity with gradually increasing activity levels. This teaching guide specifically promotes which topic? |
|
Definition
Cardiac output and tissue perfusion.
Rationale: Regular physical activity will help promote healthy cardiac functioning and will also promote tissue perfusion. With physical activity the heart muscle becomes more powerful and efficient, and the client has cardiovascular risk factors. |
|
|
Term
| Which would most likely be included in the evaluation of the client goal of “Demonstrate adequate tissue perfusion”? |
|
Definition
Brisk capillary refill
Rationale: Capillary refill is an assessment of capillary blood flow and thus tissue perfusion. |
|
|
Term
| A client is admitted with acute crushing chest pain that radiates down his left arm. The nurse expects which blood tests to be ordered for this client? Select all that apply |
|
Definition
Creatine kinase (CK)
Troponin
Rationale: Creatine kinase (CK) and troponin are enzymes that are released into the blood when there is hypoxia and myocardial damage. |
|
|
Term
| Which client is most likely to experience poor cardiac output? |
|
Definition
A client with a sustained heart rate of 150 beats/min.
Rationale: Very rapid heart rates do not allow adequate time for the ventricles to fill, causing cardiac output to fall. |
|
|
Term
| The nurse is assigned to three clients with the following diagnoses: myocardial infarction (MI), heart failure (HF), and anemia. In planning for their nursing care, the nurse knows that all three clients will have which sign/symptom? |
|
Definition
Shortness of breath
Rationale: Because the clients would experience impaired tissue perfusion resulting in respiratory compensation, they are most likely to experience the sign/symptom of shortness of breath. The client with the MI will experience cardiac impairment resulting in decreased cardiac output as well as severe chest pain resulting in increased oxygen demand with decreased availability. Clients with heart failure will have decreased pumping ability of the cardiac muscle resulting in pulmonary congestion and decreased cardiac output. Clients with anemia have fewer RBCs to carry the oxygen to the tissues, resulting in hypoxia. |
|
|
Term
| Which set of assessment data best validates that the nurse should initiate cardiopulmonary resuscitation on a comatose client? |
|
Definition
Apnea, absence of carotid or femoral pulses, dilated pupils.
Rationale: The three cardinal signs of cardiac arrest are apnea, absence of a carotid or femoral pulse, and dilated pupils. |
|
|
Term
| Which diagnoses would be most appropriate for clients with cardiovascular disease? Select all that apply. |
|
Definition
Ineffective Peripheral Tissue Perfusion
Decreased Cardiac Output
Activity Intolerance |
|
|
Term
| The surgeon ordered sequential compression devices (SCDs) to be applied postoperatively. The client asks why the SCDs are needed. Which is the best response by the nurse when teaching the client about the purpose of SCDs? |
|
Definition
Promote venous return from the legs.
Rationale: SCDs promote venous return from the legs to the heart. They inflate and deflate plastic sleeves wrapped around the legs to promote venous flow. The sequential inflation and deflation counteract blood stasis in the lower extremities. |
|
|
Term
|
Definition
| the resistance against which the heart must pump to eject blood into the circulation |
|
|
Term
|
Definition
| buildup of fatty plaque within the arteries |
|
|
Term
|
Definition
| two upper hollow chambers of the heart |
|
|
Term
| Atrioventricular (AV) node |
|
Definition
| conduction pathways that slightly delay transmission of the impulse from the atria to the ventricles of the heart |
|
|
Term
| Atrioventricular (AV) valves |
|
Definition
| between the atria and ventricles of the heart, the tricuspid valve on the right and the bicuspid or mitral valve on the left |
|
|
Term
|
Definition
| an electrical impulse and contraction independent of the nervous system and generated by the cardiac muscle |
|
|
Term
|
Definition
| the force exerted on arterial walls by blood flowing within the vessel |
|
|
Term
|
Definition
| the right and left bundle branches of the ventricular conduction pathways |
|
|
Term
|
Definition
| the cessation of heart function |
|
|
Term
|
Definition
| the amount of blood ejected by the heart with each ventricular contraction |
|
|
Term
|
Definition
|
|
Term
|
Definition
| the inherent ability of cardiac muscle fibers to shorten or contract |
|
|
Term
|
Definition
| a network of vessels known as the coronary circulation |
|
|
Term
|
Definition
| enzyme that is released into the blood during a myocardial infarction (MI) |
|
|
Term
|
Definition
| in measuring blood pressure, the period during which the ventricles relax |
|
|
Term
|
Definition
| a layer of the heart wall lining the inside of the heart's chambers and great vessels |
|
|
Term
|
Definition
| the visceral pericardium adhering to the surface of the heart, forming the heart's outermost layer |
|
|
Term
|
Definition
| condition that develops if the heart cannot keep up with the body's need for oxygen and nutrients to the tissues; usually occurs because of myocardial infarction, but it may also result from chronic overwork of the heart |
|
|
Term
|
Definition
| deficiency of blood supply caused by obstruction of circulation to the body part |
|
|
Term
| Myocardial infarction (MI) |
|
Definition
| heart attack; cardiac tissue necrosis owing to obstruction of blood flow to the heart |
|
|
Term
|
Definition
| a layer of the heart wall; cardiac muscle cells that form the bulk of the heart and contract with each beat |
|
|
Term
|
Definition
| double layer of fibroserous membrane of the heart; the parietal, or outermost, pericardium serves to protect the heart and anchor it to surrounding structures |
|
|
Term
| Peripheral vascular resistance (PVR) |
|
Definition
| impedance or opposition to blood flow to the tissues; determined by viscosity, or thickness, of the blood; blood vessel length; blood vessel diameter |
|
|
Term
|
Definition
| the degree to which muscle fibers in the ventricle are stretched at the end of diastole |
|
|
Term
|
Definition
| fibers of the ventricular conduction pathways that terminate in ventricular muscle, stimulating contraction |
|
|
Term
|
Definition
| crescent moon-shaped valves between the cardiac ventricles and the pulmonary artery (pulmonic valve) and the aorta (aortic valve) |
|
|
Term
|
Definition
| a dividing structure such as that between the cardiac chambers or between the two sides of the nose |
|
|
Term
| Sinoatrial (SA or sinus) node |
|
Definition
| the primary pacemaker of the heart located where the superior vena cava enters the right atrium |
|
|
Term
|
Definition
| the amount of blood ejected with each cardiac contraction |
|
|
Term
|
Definition
| the period during which the ventricles contract |
|
|
Term
|
Definition
| enzyme that is released into the blood during a myocardial infarction (MI) |
|
|
Term
|
Definition
| two lower chambers of the heart |
|
|
Term
|
Definition
Blood cells
Plasma
Transports oxygen, nutrients, hormones to cells
Transports wastes from tissues
Prevents infection, blood loss
Regulates body temperature, pH, fluid volume |
|
|
Term
| Nonmodifiable risks for heart disease |
|
Definition
|
|
Term
| modifiable risks for heart disease |
|
Definition
Elevated serum lipid levels
Hypertension
Cigarette smoking
Diabetes
Obesity
Sedentary lifestyle |
|
|
Term
|
Definition
-modifiable risks
-non modifiable
-Heat and cold
-Previous health status
-Stress and coping
-Dietary factors
-Alcohol intake
-Elevated homocysteine level |
|
|
Term
|
Definition
Chest pain
Substernal and/or radiating to left arm or jaw
Nausea
Shortness of breath
Diaphoresis |
|
|
Term
|
Definition
Pulmonary congestion
Adventitious breath sounds
Shortness of breath
Increased HR
Increased RR
Peripheral vasoconstriction
Cold, pale extremities
Distended neck veins |
|
|
Term
| What separates the left and right side of the heart? |
|
Definition
|
|
Term
| What is one quality of cardiac muscle that makes it unique? |
|
Definition
| It has the capacity to generate electrical impulses and contractions independently of the nervous system (automaticity). |
|
|
Term
| What are the nonmodifiable risk factors for cardiovascular disease (CVD)? |
|
Definition
|
|
Term
| What are the atrioventricular (AV) valves? |
|
Definition
| The tricuspid valve on the right and the bicuspid valve on the left. |
|
|
Term
|
Definition
| The degree to which muscle fibers in the ventricle are stretched at the end of the relaxation period (dyastole). |
|
|
Term
| What is the membrane that envelopes the heart? |
|
Definition
|
|
Term
| What is the inner most layer of the pericardium? |
|
Definition
| The visceral pericardium. |
|
|
Term
| What are the semilunar valves? |
|
Definition
| The pulmonic valve on the right and the aortic valve on the left. |
|
|
Term
| What happens if the coronary arteries are clogged? |
|
Definition
| This deprives the heart of blood and oxygen and can cause chest pain, a myocardial infarction (heart attack), or death of the heart tissue. |
|
|
Term
|
Definition
- it acts as the major transportation system of the body.
- brings oxygen and nutrients to the cells
- removes waste for disposal from the body |
|
|
Term
| What are the phases of of the cardiac cycle (heartbeat)? |
|
Definition
- Contraction (systole)
- Relaxation (diastole) |
|
|
Term
|
Definition
| The resistance that the ventricle must overcome during systole to eject blood into circulation. |
|
|
Term
| What is a sinus arrythmia? |
|
Definition
| Heart rate that increases and decreases with each breath |
|
|
Term
| What does the parietal pericardium do? |
|
Definition
| Anchor the heart to surrounding structures and protects the heart. |
|
|
Term
| What valve separates the right atrium from the right ventricle? |
|
Definition
|
|
Term
|
Definition
| - Cardiac muscle cells that form the bulk of the heart and contract with each beat. |
|
|
Term
|
Definition
- The second sound
- Beginning of ventricular dystole; the sound is caused by closure of the semilunar valves - the aortic and pulmonic. |
|
|
Term
| What is the leading cause of death in North America? |
|
Definition
|
|
Term
| What is the outermost layer of the pericardium referred to as? |
|
Definition
| The parietal pericardium. |
|
|
Term
|
Definition
| When the ventricles fill with blood. |
|
|
Term
| How does heredity affect the risk of CVD? |
|
Definition
- Genes
- If a pt. has a parent with CVD the pt. is at greater risk for developing it.
- Certain racial and ethnic groups (ex. African Americans) are at a higher risk of developing CVD. |
|
|
Term
| What is the heart rate of an infant to 2 year old? |
|
Definition
|
|
Term
| What is considered the pacemaker of the heart? |
|
Definition
| The Sinoatrial node (SA or Sinus node). |
|
|
Term
|
Definition
| When the heart ejects (propels) the blood into pulmonary and systemic circulation. |
|
|
Term
| What does the visceral pericardium do? |
|
Definition
Adheres to the surface of the heart and acts to protect the heart.
Forms the epicardium. |
|
|
Term
| When are pulse rates highest and most variable? |
|
Definition
|
|
Term
|
Definition
| - Lines the inside of the heart's chambers and great vessels. |
|
|
Term
| What is the purpose of valves in the heart? |
|
Definition
| To direct the flow of blood and prevent backflow. |
|
|
Term
| What valve separates the left atrium from the left ventricle? |
|
Definition
|
|
Term
| What is the resting heart rate for neonates? |
|
Definition
| 100 to 180 beats per minute immediately after birth and stabilizes at 100 to 150. |
|
|
Term
| Where does oxygenated blood enter the heart? |
|
Definition
|
|
Term
| What influences heart rate? |
|
Definition
- autonomic nervous system
- blood pressure
- hormones (thyroid hormone)
- medications |
|
|
Term
| What is the adult heart rate and when is it reached? |
|
Definition
- 60 to 95 beats per minute.
- obtained at 10 years old. |
|
|
Term
|
Definition
- The first sound of a heartbeat.
- Beginning of ventricular systole; the second is caused by closure of the atrioventricular valves - the tricuspid and the mitral. |
|
|
Term
| What is the primary contributor to cardiovascular disease? |
|
Definition
|
|
Term
| Where does deoxygenated blood enter the heart? |
|
Definition
|
|
Term
| What are coronary arteries? |
|
Definition
(aka coronary circulation)
- Encircle and penetrate the myocardium
- Replenish the heart during ventricular relaxation. |
|
|
Term
| What are they two layers of the heart wall? |
|
Definition
- myocardium
- endocardium |
|
|
Term
| What are the affects of poor cardiac output? |
|
Definition
- Oxygen and nutrients do not reach cells
- Impaired tissue perfusion |
|
|
Term
| How does arteriosclerosis affect blood pressure? |
|
Definition
| It causes BP to increase because of the narrowing diameter (lumen) and decrease in ability to dilate of blood vessels. |
|
|
Term
| Where does deoxygenated blood enter the heart? |
|
Definition
|
|
Term
| clients with elevated levels of homocysteine are at increased risk for what? |
|
Definition
-Myocardial infarction
-Cardiovascular disease
-cerebrovascular accidents (stroke)
-periphreal vascular disease |
|
|
Term
| conditions that increase preload |
|
Definition
-hypervolemia
-valvular disorders such as mitral regurgitation
-congenital defects such as patent ductus arteriosus |
|
|
Term
| conditions that increase afterload |
|
Definition
-hypertension
-atherosclerosis |
|
|
Term
| conditions that affect myocardial function |
|
Definition
-myocardial infarction
-cardiomyopathy
-coronary artery disease |
|
|
Term
| signs or impaired peripheral arterial circulation |
|
Definition
-decreased peripheral pulses
-pain or parethesias
-pale skin color
-cool extremities
-decreased hair distribution |
|
|
Term
| what is important to remember about ECG monitoring? |
|
Definition
it ONLY measures electrical activity of the heart
it DOES NOT reflect mechanical contraction and cardiac output |
|
|
Term
| what enzyme levels should be measured when examining a patient that may have had a MI? |
|
Definition
|
|
Term
| high levels of creatine kinase & troponin in the blood indicate what? |
|
Definition
|
|
Term
| intervention for deep vein thrombosis |
|
Definition
-positioning- high flowlers(legs elevated EXCEPT in clients with cardiac dysfunction)
-leg exercises
-antiemboli stockings
-sequential compression devices |
|
|
Term
| what disease is someone with a high C-reactive protein assay at risk for? |
|
Definition
|
|
Term
| How does age influence the risk of developing CVD? |
|
Definition
- CVD mostly affects those 60 years and older.
- Lifestype behaviors associated with CVD (patterns of diet, physical activity, and tobacco use) are established in early childhood and influence the development of CVD risk factors later in life. |
|
|
Term
| How does gender influence the risk of developing CVD? |
|
Definition
- In women estrogen slows the progression of atherosclerosis and reduces the risk of CVD. This is lost after menopause and women have the same risk for CVD as men from this point forward.
- Men are at a greater risk for developing CVD. |
|
|
Term
| What are the modifiable risks of coronary heart disease (CVD)? |
|
Definition
- elevated serum lipid levels
- hypertension
- cigarette smoking
- diabetes
- obesity
- sedentary lifestyle |
|
|
Term
|
Definition
| Lipid disorders characterized by abnormalities of lipoprotein metabolism and include elevations of total cholesterol, LDL cholesterol, or triglycerides; or deficiencies of HDL cholesterol. |
|
|
Term
| How does hypertension increase the risk of coronary heart disease (CVD)? |
|
Definition
- increases the workload of the heart, increasing oxygen demand and coronary blood flow, causing hypertrophy of ventricles causing heart failure over time.
- causes endothelial damage to blood vessels, stimulating the development of atherosclerosis. |
|
|
Term
| How does cigarette smoking increase the risk of coronary heart disease (CVD)? |
|
Definition
Nicotine increases heart rate, blood pressure, and peripheral vascular resistance, increasing the heart's workload.
- Causes vasoconstriction which can lead to a decrease in oxygen in areas of the body when combined with atherosclerosis. |
|
|
Term
| How does diabetes increase the risk of coronary heart disease (CVD)? |
|
Definition
| - high glucose levels are associated with accelerated development of atherosclerosis and levels of serum lipids and triglycerides. |
|
|
Term
| How does obesity increase the risk of coronary heart disease (CVD)? |
|
Definition
- Obesity is often accompanied with elevated serum lipid levels, hypertension, and diabetes.
- Obesity places an increased workload on the heart, which increases oxygen demand. |
|
|
Term
| How does a sedentary lifestyle increase the risk of coronary heart disease (CVD)? |
|
Definition
- Regular activity increases the heart rate and supply of oxygen to the body.
- Regular activity encourages the heart muscle to become more powerful and efficient and reduces the atherosclerotic process, risk of coronary heart disease, obesity, and diabetes. |
|
|
Term
| What are 3 nontraditional risk factors for developing coronary heart disease (CVD)? |
|
Definition
- Metabolic syndrome (Met-S)
- C-Reactive Protein
- Elevated Homocycteine Level |
|
|
Term
| What are other risk factors for developing coronary heart disease? |
|
Definition
Heat and cold
- previous health status
- stress and coping
- dietary factors
- alcohol intake
- elevated homocysteine level |
|
|
Term
| What are the 5 risk factors for developing metabolic syndrome? |
|
Definition
- Central obesity (excess fat around stomach)
- Increased triglycerides
- Low HDL cholesterol
- Hypertension
- Elevated Fasting glucose levels |
|
|
Term
| How does C-reactive protein (CRP) increase the risk of coronary heart disease (CVD)? |
|
Definition
| - CRP signals an increase in the inflammatory process which puts a pt. at greater risk of MI. |
|
|
Term
| How does Homocysteine increase the risk of coronary heart disease (CVD)? |
|
Definition
homocysteine is an amino acid that has been shown to be elevated in people with atheroclerosis.
- By knowing the level of this protein a pt. can reduce their risk of MI and CVD by changing their lifestyle. |
|
|
Term
| Cardiovascular function can be altered by conditions affecting what 3 things |
|
Definition
The function of the heart as a pump.
- Blood flow to organs and peripheral tissues
- The composition of the blood and its ability to transport oxygen and carbon dioxide. |
|
|
Term
| What are three major alterations in cardiovascular function? |
|
Definition
-Decreased cardiac output
- Impaired tissue perfusion
- Disorders that affect the composition or amount of blood available for transport of gases. |
|
|
Term
| What are the signs and symptoms of a MI? |
|
Definition
- Chest pain; substernal and/or radiating to the left arm, jaw
- Nausea
- Shortness of breath
- Diaphoresis |
|
|
Term
| What are the signs and symptoms of heart failure? |
|
Definition
- Pulmonary congestion; adventitious lung sounds
- Shortness of breath
- Dyspnea on exertion (DOE)
- Increased heart rate
- S3 heart sounds
- Increased respiratory rate
- Nocturia
- Orthopnea
- Distended neck veins
- Cold, pale extremities |
|
|
Term
| What causes a decrease in cardiac output? |
|
Definition
- Myocardial Infarction (MI)
- Heart Failure
- Irregular heart rhythms
- Structural heart conditions |
|
|
Term
| What are examples of conditions that may precipitate heart failure? |
|
Definition
- Conditions that increase preload
* Hypervolemia, Valvular Disorders, Congenital defects.
- Conditions that increase afterload
* Hypertension, atherosclerosis
- Conditions that affect myocardial function
* MI, Cardiomyopathy, Coronary Artery Disease |
|
|
Term
| What are the signs of impaired circulation in the legs and feet? |
|
Definition
- Decreased peripheral pulses
- Pain or paresthesias
- Pale skin color
- Cool extremities
- Decreased hair distribution |
|
|
Term
| What are the risk factors for peripheral atherosclerosis? |
|
Definition
- cigarette smoking
- high fat intake
- obesity
- sedentary lifestyle
- hypertension
- diabetes |
|
|
Term
| what are less frequent factors increasing the risk for atherosclerosis? |
|
Definition
- Vascular inflammation
- Arterial spasm
- Blood clots occluding blood vessels
- Tissue edema
- Incompetent valves in veins |
|
|
Term
| What can be caused by incompetent valves? |
|
Definition
- blood pooling in veins
- edema
- decreasing venous return to the heart
- inflammation
- clots (thrombi) |
|
|
Term
| What are the signs and symptoms of an acute pulmonary embolism? |
|
Definition
- Sudden onset of shortness of breath
- Pleuritic chest pain |
|
|
Term
| What are the signs and symptoms of anemia? |
|
Definition
- Chronic fatigue
- Pallor
- Shortness of breath
- Hypotension |
|
|
Term
| What is a risk of anemia? |
|
Definition
| Not enough oxygen being circulated by the blood. |
|
|
Term
| What causes hypovolemia and are risks associated with it? |
|
Definition
Causes are hemorrhage or severe dehydration, blood pressure and cardiac output fall.
Can lead to tissue becoming ischemic. |
|
|
Term
| What causes hypervolemia and are the risks associated with it? |
|
Definition
Causes are from excessive fluid retention from kidney failure.
Risks are the development of heart failure, peripheral edema, and tissue ischemia. |
|
|
Term
| What should a comprehensive nursing history include for cardiovascular health? |
|
Definition
Current and past cardiovascular problems
- Family history of cardiovascular problems
- Medical history
- Exercise and activity level
- History of Tobacco use
- Diet
- Presence of symptoms
- Medications
- Lifestyle |
|
|
Term
| What is the first step in examining the cardiovascular system? |
|
Definition
Taking blood pressure in both arms and takes pulse in both arms.
Check apical pulse to peripheral pulses.
Listen for bruits in carotid arteries.
Listen to lungs for adventitious sounds. |
|
|
Term
| What two enzymes are released into the blood during a heart attack? |
|
Definition
- creatine kinase
- troponin |
|
|
Term
|
Definition
The study of the forces or pressures involved in blood circulation.
- used to evaluate the fluid status and cardiovascular function |
|
|
Term
| Ineffective Peripheral Tissue Perfusion |
|
Definition
| Decrease in blood circulation to the periphery that may compromise health |
|
|
Term
| Risk for Decreased Cardiac Tissue Perfusion |
|
Definition
| Risk for a decrease in cardiac (coronary) circulation |
|
|
Term
|
Definition
| Inadequate blood pumped by the heart to meet metabolic (demands) of the body |
|
|
Term
|
Definition
| Insufficient physiological or psychological energy to endure or complete required or desired daily activities. |
|
|
Term
| Three ways to help maintain adequate cardiovascular functioning. |
|
Definition
- changing position frequently
- ambulating
- exercising |
|
|
Term
| Nursing interventions for the circulatory system can be divided into two categories |
|
Definition
- cardiac function
- vascular function |
|
|
Term
| Vascular Nursing Interventions |
|
Definition
- Elevate the legs to promote venous return
- Avoid pillows under the knees or more than 15 degrees of knee flexion
- Encourage leg exercises
- Encourage or provide frequent position changes |
|
|
Term
| Cardiac Nursing Interventions |
|
Definition
- position the client in high Fowler's position to decrease preload and reduce pulmonary congestion
- Monitor intake and output |
|
|
Term
| What drugs reduce the workload of the heart and prevent vasoconstriction? |
|
Definition
- nitrates
- calcium channel blockers
- angiotensin-converting enzyme (ACE) inhibitors |
|
|
Term
| What drugs cause the contractile strength of the heart to increase? |
|
Definition
|
|
Term
| What methods are used to prevent venous stasis? |
|
Definition
- exercises
- position changes
- antiemboli stockings
- sequential compression devices |
|
|
Term
| What would most likely be included in the evaluation of the client goal of "demonstrates adequate tissue perfusion" |
|
Definition
|
|
Term
| Would a client who has a sustained heart rate of 150 beats/minute experience poor cardiac output? |
|
Definition
| Yes, A fast heart rate doesn't allow for the ventricles to refill. |
|
|
